|
Estradiol Level
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$342.96 |
| Max. Negotiated Rate |
$643.93 |
| Rate for Payer: Aetna Commercial |
$629.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.96
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$643.93
|
| Rate for Payer: Health EOS Commercial |
$622.93
|
| Rate for Payer: HFN Commercial |
$643.93
|
| Rate for Payer: Multiplan Commercial |
$559.94
|
| Rate for Payer: Preferred Network Access Commercial |
$643.93
|
| Rate for Payer: Quartz Beloit One Network |
$342.96
|
| Rate for Payer: Quartz Commercial |
$419.95
|
| Rate for Payer: WEA Trust Commercial |
$384.96
|
| Rate for Payer: WPS Commercial |
$518.41
|
|
|
Estradiol Level
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$643.93 |
| Rate for Payer: Aetna Commercial |
$629.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.93
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.24
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$643.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$622.93
|
| Rate for Payer: HFN Commercial |
$643.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$559.94
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$643.93
|
| Rate for Payer: Quartz Beloit One Network |
$342.96
|
| Rate for Payer: Quartz Commercial |
$454.95
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: United Healthcare PPO |
$524.94
|
| Rate for Payer: WEA Trust Commercial |
$384.96
|
| Rate for Payer: Wellcare Medicare |
$29.06
|
| Rate for Payer: WPS Commercial |
$518.41
|
|
|
Estradiol Level
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$664.92 |
| Rate for Payer: Aetna Commercial |
$664.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.93
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$664.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$349.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$636.93
|
| Rate for Payer: HFN Commercial |
$664.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$559.94
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$664.92
|
| Rate for Payer: Quartz Beloit One Network |
$307.96
|
| Rate for Payer: Quartz Commercial |
$398.95
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$114.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$384.96
|
| Rate for Payer: WPS Commercial |
$127.85
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.24
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: United Healthcare PPO |
$83.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: Wellcare Medicare |
$29.06
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$127.85 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$114.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$127.85
|
|
|
Estradiol valerate 10 mg inj J1380
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
Estradiol valerate 10 mg inj J1380
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna Commercial |
$43.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$7.75
|
| Rate for Payer: Anthem Medicare Advantage |
$7.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.75
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$41.64
|
| Rate for Payer: HFN Commercial |
$43.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$11.62
|
| Rate for Payer: Preferred Network Access Commercial |
$43.47
|
| Rate for Payer: Quartz Beloit One Network |
$20.13
|
| Rate for Payer: Quartz Commercial |
$26.08
|
| Rate for Payer: Quartz Medicare Advantage |
$7.75
|
| Rate for Payer: The Alliance Commercial |
$21.31
|
| Rate for Payer: United Healthcare Medicaid |
$7.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.75
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$22.51
|
|
|
Estradiol valerate 10 mg inj J1380
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.91
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$30.99
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$22.51
|
|
|
Estriol Free
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
Estriol Free
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$25.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.74
|
| Rate for Payer: Anthem Medicare Advantage |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.15
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.15
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$37.72
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$25.15
|
| Rate for Payer: The Alliance Commercial |
$100.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.15
|
| Rate for Payer: United Healthcare PPO |
$247.26
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
Estriol Free
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$25.15
|
| Rate for Payer: Anthem Medicare Advantage |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.15
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$313.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.15
|
| Rate for Payer: Health EOS Commercial |
$300.01
|
| Rate for Payer: HFN Commercial |
$313.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$37.72
|
| Rate for Payer: Preferred Network Access Commercial |
$313.20
|
| Rate for Payer: Quartz Beloit One Network |
$145.06
|
| Rate for Payer: Quartz Commercial |
$187.92
|
| Rate for Payer: Quartz Medicare Advantage |
$25.15
|
| Rate for Payer: The Alliance Commercial |
$99.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.15
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$110.65
|
|
|
Estriol Level
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$25.15
|
| Rate for Payer: Anthem Medicare Advantage |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.15
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.15
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.72
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: Quartz Medicare Advantage |
$25.15
|
| Rate for Payer: The Alliance Commercial |
$99.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.15
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$110.65
|
|
|
Estriol Level
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Estriol Level
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$25.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.74
|
| Rate for Payer: Anthem Medicare Advantage |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.15
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.15
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.72
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$25.15
|
| Rate for Payer: The Alliance Commercial |
$100.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.15
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Estrogens, Fractionated
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Estrogens, Fractionated
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.59 |
| Max. Negotiated Rate |
$487.08 |
| Rate for Payer: Aetna Commercial |
$487.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$33.59
|
| Rate for Payer: Anthem Medicare Advantage |
$33.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.59
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$487.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.59
|
| Rate for Payer: Health EOS Commercial |
$466.58
|
| Rate for Payer: HFN Commercial |
$487.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.59
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$50.39
|
| Rate for Payer: Preferred Network Access Commercial |
$487.08
|
| Rate for Payer: Quartz Beloit One Network |
$225.60
|
| Rate for Payer: Quartz Commercial |
$292.25
|
| Rate for Payer: Quartz Medicare Advantage |
$33.59
|
| Rate for Payer: The Alliance Commercial |
$132.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.59
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$147.80
|
|
|
Estrogens, Fractionated
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.59 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$33.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.76
|
| Rate for Payer: Anthem Medicare Advantage |
$33.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.59
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.59
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.59
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$50.39
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$33.59
|
| Rate for Payer: The Alliance Commercial |
$134.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.59
|
| Rate for Payer: United Healthcare PPO |
$384.54
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: Wellcare Medicare |
$33.59
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Estrogens Total
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
Estrogens Total
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$22.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.46
|
| Rate for Payer: Anthem Medicare Advantage |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.57
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.57
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.57
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$33.85
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$22.57
|
| Rate for Payer: The Alliance Commercial |
$90.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.57
|
| Rate for Payer: United Healthcare PPO |
$338.52
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$22.57
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
Estrogens Total
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$22.57
|
| Rate for Payer: Anthem Medicare Advantage |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.57
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.57
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.57
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$33.85
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: Quartz Medicare Advantage |
$22.57
|
| Rate for Payer: The Alliance Commercial |
$89.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.57
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$99.30
|
|
|
Estrone Level
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.95
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.95
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.95
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$38.92
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: Quartz Medicare Advantage |
$25.95
|
| Rate for Payer: The Alliance Commercial |
$102.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.95
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$114.17
|
|
|
Estrone Level
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$25.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.07
|
| Rate for Payer: Anthem Medicare Advantage |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.95
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.95
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.95
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$38.92
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$25.95
|
| Rate for Payer: The Alliance Commercial |
$103.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.95
|
| Rate for Payer: United Healthcare PPO |
$338.52
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$25.95
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
Estrone Level
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
Ethanol Level
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
1037117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$332.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.29
|
| Rate for Payer: Health EOS Commercial |
$318.94
|
| Rate for Payer: HFN Commercial |
$332.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$332.96
|
| Rate for Payer: Quartz Beloit One Network |
$154.21
|
| Rate for Payer: Quartz Commercial |
$199.77
|
| Rate for Payer: The Alliance Commercial |
$175.24
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
